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Center for Clinical & Basic Research, Ballerup Byvej 222, DK-2750 Ballerup, Denmark.
a Author for correspondence. Fax +45 44 68 42 20; e-mail byrjal{at}biobase.dk
| Abstract |
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Key Words: indexing terms: vitamin D status steroid hormones cholecalciferol EIA covalent coupling
| Introduction |
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Several analytical principles have been applied for the measurement of 25(OH)D in serum or plasma, such as HPLC (9)(10)(11), competitive protein-binding assay (11)(12)(13)(14)(15)(16), and RIA (17)(18)(19). The HPLC methods are very time consuming, requiring extensive purification steps, and the competitive protein-binding assays require both solvent extraction and chromatographic purification before assay. The introduction of antibody preparations against vitamin D metabolites made it possible to develop assays that generally are more specific vitamin D assays, thus requiring fewer purification steps. Traditionally, the RIAs have been based on a 3H-labeled tracer, but the use of a 125I-labeled tracer has been described, thus avoiding the time-consuming liquid scintillation counting (19).
An enzyme immunoassay (EIA) would represent a new approach to perform vitamin D analysis. Microtiter plates with secondary amino groups grafted onto the polystyrene surface have been introduced, giving the opportunity of covalent coupling of peptides or steroid derivatives to the surface (20)(21). We report here the development and assay performance of the first described competitive EIA for the measurement of 25(OH)D3 in serum with this new approach of covalent linkage of a hemisuccinate derivative of 25(OH)D3 to the microtiter plates.
| Materials and Methods |
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The buffers used were: PBS: 1.5 mmol/L KH2PO4, 8.5 mmol/L Na2HPO4 · 2H2O, 2.7 mmol/L KCl, 0.137 mol/L NaCl, pH 7.2; washing buffer: 25 mmol/L Tris, 50 mmol/L NaCl, 1.0 g/L Tween 20, 0.025 g/L thimerosal, pH to 7.2 with HCl; assay buffer: 0.1 mol/L NaH2PO4 · H2O, 50 g/L skim milk powder, 5 g/L BSA, pH 7.2.
Human serum samples were obtained from in-house employees ages 25 to 40 years and healthy volunteers ages 70 to 78 years, who gave their informed consent for the analysis.
coupling of 25(oh)d3 to the microtiter plate
Immediately before preactivation, 100 µL of freshly prepared
3.75 mol/L N-hydroxysuccinimide (NHS) was gently mixed with
an equal volume of freshly prepared 7.5 mol/L
1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC). For
preactivation, 45 µL of 25(OH)D3-3-hemisuccinate (10
µg/100 µL in 1,4-dioxane) was gently mixed with 90 µL of the
NHS-EDC solution and left for 20 to 40 min at room temperature. The
preactivated mixture was diluted with 11.25 mL of PBS containing 40
µmol/L chloramine T, and 100 µL was applied per well of the 96-well
CovaLink plate. The plate was covered with sealing tape and left for
covalent coupling overnight at room temperature. After coupling, the
wells were emptied and short-time blocked with 200 µL of PBS
containing 50 g/L skim milk powder and 10 µL/L Tween 20 for 2 to 4
min, without shaking. The wells were emptied and further blocked by
addition of 200 µL of PBS containing 50 g/L skim milk powder. The
plate was blocked for 1 h and the EIA plate was used the same day
or stored in a foil bag with a drying capsule at 4 °C.
sample extraction procedure
Horse serum [intrinsically low in 25(OH)D] enriched with
25(OH)D3 was used as calibrator. The calibrator was
prepared (twofold serial dilutions, 175 to 2.7 µg/L) each day of
analysis. Extraction of 25(OH)D3 from the serum samples and
the calibrators was performed by slowly pipetting 100 µL of sample
below the surface of 500 µL of acetonitrile in conical glass tubes.
The tubes were vortex-mixed for 15 s, left for 15 min, and
centrifuged at 3000g for 5 min at 4 °C. Four hundred
microliters of the supernatant was transferred to conical glass tubes,
evaporated to dryness under air at 40 °C, and redissolved in 20 µL
of acetonitrile. The redissolved extract was further diluted with 180
µL of assay buffer before assay.
eia procedure
Incubations and preincubations were done in wells of microtiter
plates, covered with sealing tape on a horizontal rotating shaker at
250 to 300 rpm (InterMed, Roskilde, Denmark). All determinations were
performed in duplicate and all steps were carried out at room
temperature.
Seventy-five microliters of redissolved sample or calibrator extract was pipetted into the well of a mixing plate and incubated with 75 µL of 1,25(OH)2D3 antiserum diluted 1:1000 in assay buffer. The mixture was preincubated for 2 h and 100 µL of this incubation mixture was transferred to the prepared EIA plate and then incubated for 1 h. The wells were emptied and washed four times with washing buffer. Peroxidase-labeled antibody raised against rabbit immunoglobulins was diluted 1:500 in 0.1 mol/L NaH2PO4 · H2O pH 7.2, 100 µL was added to each well, and the plate was incubated for 1 h. After the plate was emptied and washed, 100 µL of the TMB solution was added to each well. The plate was incubated for 30 min in darkness before the enzymatic reaction was stopped by adding 100 µL of 1 mol/L H3PO4 directly to the wells. The absorbance was read at 450 nm with a microtiter plate reader, with correction for absorbance at 650 nm.
cross-reactivity
For estimation of cross-reactivity, different vitamin D
metabolites were dissolved in absolute ethanol and
spectrophotometrically quantified at 265 nm. Each metabolite was
further diluted in 500 mL/L ethanol to produce the desired
concentration range. Aliquots of these solutions were dried under air
and subsequently redissolved as previously described in the sample
extraction procedure. The calibration curve of each metabolite was
drawn and the concentration that equalled the signal corresponding to
50% displacement of the 25(OH)D3 was read. The
cross-reactivity was defined as the ratio between the read
concentration of 25(OH)D3 and the test metabolite.
lipid interference
For estimation of lipid interference, a pool of hyperlipidemic
rabbit sera was mixed in six ratios with ultracentrifuged sera of the
same pool, thereby producing identical serum samples but with
increasing degree of lipemia. A human serum sample was enriched with
these six mixtures of rabbit sera (75% human serum and 25% rabbit
serum). The rabbit mixtures and the enriched human serum sample were
measured in the EIA, and total cholesterol and triglycerides were
determined by standard routine procedures. This procedure was carried
out twice with different rabbit and human serum samples.
statistical analysis
SAS Institute procedures were used for statistical analysis
(23). The EIA results were compared with results obtained
by RIA, in which serum samples were extracted with acetonitrile and
subsequently chromatographically purified as described elsewhere
(17). The significance of the mean differences between
groups was assessed by Student's t-test for paired data and
regression lines were based on orthogonal regression (Deming's linear
regression) (24).
| Results |
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The coupling efficiency was dependent on the concentrations of EDC and
NHS and preactivation. Optimal preactivation conditions were determined
by combining serial dilutions of EDC with serial dilutions of NHS, and
the optimal concentrations in the preactivation mixture were found to
be 2.5 mol/L EDC and 1.25 mol/L NHS. These concentrations were lowered
by dilution in PBS before transferring to the microtiter wells. Initial
experiments without preactivation showed very low and insufficient
coupling efficiency. Generally, the coupling efficiency was lowered if
the EDC and NHS were not prepared immediately before use. The addition
of chloramine T to the PBS made the coupling procedure more
reproducible and also increased the coupling efficiency. As seen in
Fig. 1
, more than a twofold increase in maximum signal was observed
when including 20 to 80 µmol/L chloramine T in the coupling mixture,
whereas no increase in nonspecific signal was observed. The effect of
adding from 0 to 80 ng/100 µL of
25(OH)D3-3-hemisuccinate to the microtiter well is
shown in Fig. 2
. Increasing coupling concentration increased the maximum signal
until it leveled off. Similar maximum coupling was obtained with 40 to
80 ng per 100 µL, and coupling with 40 ng/100 µL equal to 7.9
x 10-11 mol/100 µL was selected. When all these
molecules were coupled, 48% of the functional groups of the well were
occupied, as each well contains 1.7 x 10-10 mol
functional groups (21).
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After coupling of the 25(OH)D3-3-hemisuccinate, the wells were blocked with PBS containing skim milk powder to decrease the nonspecific binding of the antiserum. Short-time blocking with 10 µL/L Tween 20 in PBS containing 50 g/L skim milk powder before blocking increased the maximum signal, while the nonspecific signal was not increased.
The prepared EIA plates could be stored at 4 °C in sealed foil bags with a drying capsule without loss of reactivity for at least 3 months.
sample extraction procedure
The effect of the serum volume on extraction recovery was examined
to ensure sufficient and reproducible extraction recovery. This
experiment was based on
[3H]25(OH)D3-labeled serum samples that
were either extracted with acetonitrile or diluted with PBS. Volumes of
serum ranging from 25 to 200 µL were extracted with the same
efficiency of 83% ± 2.8% (mean ± SD). When 250 µL of serum
was extracted, the extraction recovery decreased to 66%, so in the
final version of the EIA we chose a volume of 100 µL of serum for
extraction. Correction for extraction recovery was omitted because the
extraction recovery was reproducible and calibrators were extracted in
parallel to the samples in the assay.
The dried sample extract was redissolved in 20 µL of acetonitrile before further dilution with 180 µL of assay buffer. If >40 µL of acetonitrile was used for redissolution, the nonspecific signal of the EIA increased. Redissolving the dried extract in acetonitrile before adding the assay buffer was important to dissolve the 25(OH)D3. If the acetonitrile and assay buffer were added simultaneously, less than half of the 25(OH)D3 was redissolved, as compared with the sequential addition. Acetonitrile was chosen for redissolution, since ethanol increased the nonspecific signal of the EIA.
assay performance
In an assay buffer system without skim milk powder and BSA, the
nonspecific binding of the primary antibody was pronounced, whereas the
addition of skim milk powder and BSA diminished this effect. On the
other hand there was no detectable problem with nonspecific binding of
the secondary antibody, so this antibody was incubated in assay buffer
without skim milk powder and BSA. The effect on the signal of the
incubation temperature was examined. Incubation of the antiserum at
room temperature and 4 °C gave comparable results, and incubation at
room temperature was chosen. To increase the sensitivity and thereby
allow measurement of samples within the reference interval, sequential
incubation, i.e., preincubation at a mixing plate before incubation at
the EIA plate, was examined. When using sequential incubation, the
detection limit decreased approximately five times compared with direct
incubation. The detection limit became 4.4 ± 2.4 µg/L
(mean ± SD, on the basis of three experiments), defined as the
concentration corresponding to the mean absorbance of 10 determinations
of the zero calibrator - 2SD of the absorbance. The calibration
curve was approximately linear in the range 1550 µg/L when plotted
on a log-linear basis. Fig. 3
shows a typical calibration curve and serial dilutions of four
samples. The serum samples were extracted and subsequently diluted in
assay buffer before analysis. The curves of the diluted samples were
parallel to the calibration curve, demonstrating that human
25(OH)D3 (in serum samples) and 25(OH)D3
(in the calibrator) had the same ability to displace the signal in the
EIA. Similar results were obtained when the serum samples were diluted
with horse serum before extraction.
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Estimation of imprecision was performed by measurements of serum
samples analyzed on different days. The result is given as the mean CV
(Table 1
). For data in the reference range (1550 µg/L) the
within-run CV on the plate was 11%, calculated from duplicate
determinations of 139 samples measured in 10 days, 5 to 22 samples each
day. The within-run CV including the extraction procedure was 12%,
determined by analysis of 21 samples distributed over 9 days, extracted
twice and subsequently measured in the EIA. The between-run CV was
15%, based on repeated measurements of three serum samples ranging 15
to 43 µg/L, which were extracted and analyzed in 6 to 10 runs over 4
1/2 months. The analytical recovery of the EIA was determined by adding
diminutive volumes of the 25(OH)D3 calibration doses
corresponding to 10, 12.5, 20, 25, 40, and 50 µg/L to four serum
samples. These enriched samples were equilibrated for 30 min, stored at
-20 °C, and extracted and assayed in the EIA in 3 to 6 different
days. Estimation of analytical recovery was performed by dividing
sample differences with the added concentrations. The overall
analytical recovery of 25(OH)D3 was 102% ± 13%
(mean ± SD) (Table 2
).
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The specificity of this EIA was assessed by measuring the extent to
which related vitamin D metabolites could displace the signal. The
vitamin D metabolites were measured simultaneously in the EIA, and the
calibration curves were drawn. The concentration of each metabolite
that was required to reach 50% displacement, i.e., the mean of total
and nonspecific signal, was compared with that of
25(OH)D3. The result is given as the mean value of two
experiments. Minimal cross-reactivity was seen with vitamin
D2 metabolites, whereas the cross-reactivity with vitamin
D3 metabolites was higher.
24,25(OH)2D3 competes half as much as
25(OH)D3, and 1,25(OH)2D3, which in
serum is 1000-fold lower in abundance than 25(OH)D3,
competes 10-fold better than 25(OH)D3 (Table 3
). To examine to what extent the EIA was affected by lipid
interference, identical serum samples but with increasing degree of
lipemia were measured in the EIA. The concentration of
25(OH)D3 was unaffected by increased degree of lipemia,
i.e., the total cholesterol content in the two series of rabbit sera
increased from 7.7 to 16.6 mmol/L and from 7.0 to 20.4 mmol/L, and
triglycerides increased from 0.34 to 1.28 mmol/L and from 0.57 to 4.00
mmol/L.
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The EIA was compared with a RIA in which serum samples were extracted
with acetonitrile and subsequently chromatographically purified
(17). Both assays were based on the same antibody
preparation. When values obtained in the EIA were plotted against
values obtained in the RIA, a linear relation was observed. The slope
of the orthogonal regression line was 1.27 ± 0.12 (mean ±
SD) and the intercept was -2.3 ± 0.1 µg/L (r =
0.76) (Fig. 4
). The mean serum concentration of 25(OH)D3 was 35.2
µg/L when estimated in the EIA and 29.6 µg/L when estimated in the
RIA. This rather small difference (5.6 µg/L) was, however, highly
significantly different from zero by a t-test for paired
data (P <0.001).
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| Discussion |
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The 25(OH)D3-3-hemisuccinate was preactivated with high concentrations of EDC and NHS, whereupon it was diluted in PBS to minimize the concentrations during coupling as described elsewhere (20). It is important that the EDC and NHS solutions be freshly prepared (21). In the present study the efficiency of the covalent coupling was initially rather unreproducible, but optimization of the EDC and NHS concentrations and, above all, the addition of chloramine T improved the coupling efficiency. The observed effect of chloramine T on the coupling process is not clearly understood and it may be unique for the coupling of hemisuccinate derivatives. In the present study the coupling solution of 25(OH)D3-3-hemisuccinate was 40 ng/100 µL, and ~48% of the functional groups in the well were occupied. This number is comparable with another study in which ~60% of the functional groups were occupied (20).
All vitamin D assays described so far require some serum pretreatment in which vitamin D is dissociated from the vitamin D binding protein. The pretreatment involves extraction with an organic solvent and often subsequent chromatographic purification. In the present study and in a very few other assays, until now solely RIAs, the extraction procedure was facilitated because it does not include a chromatographic step (18)(19). The extraction recovery of 25(OH)D3 observed in the present study was comparable with other vitamin D studies (12)(13)(14)(28). We used the same pretreatment of the calibrators and the serum samples, and hence the correction for extract recovery was omitted.
The within-run and between-run variations observed in this EIA were similar to those observed in other vitamin D assays, and so was the accuracy (13)(15)(19)(28). The antiserum used in the EIA and the RIA was directed towards 1,25(OH)2D3-3-hemisuccinateBSA. In the EIA this antiserum also reacted with 25(OH)D3, less with 24,25(OH)2D3, and much less with vitamin D2 metabolites and unhydroxylated vitamin D3. The cross-reactivity with 1,25(OH)2D3 and 24,25(OH)2D3 presents no clinical problem, as the circulating concentration of 1,25(OH)2D3 is only about one thousandth of that of 25(OH)D3[4, 29], and the concentration of 24,25(OH)2D3 is only ~10% compared with 25(OH)D3 [4], thus suggesting a contribution by cross-reacting vitamin D metabolites of <5% of the typically estimated concentration of 25(OH)D3 in serum.
The comparison between the results from the EIA and the more cumbersome RIA showed reasonable accordance. The EIA values were on average 19% higher than the RIA values, the difference being highly significant. On the basis of our experiments of cross-reactivity, only a few percent of this overestimation might be explained by cross-reacting vitamin D metabolites. However, spuriously increased concentrations of 25(OH)D3 have been explained by lipid interference (10), especially in nonchromatographic protein binding assays compared with chromatographic protein binding assays. The present EIA is based on antibodies, which are more specific than the binding protein, and thus should be less affected by nonspecific lipid interference. We found that the lipid interference was negligible in this EIA, and, as yet, we have no explanation for the overestimation of the present EIA as compared with the RIA. However, it is not unusual that different vitamin D assays measure different values (29)(30), implicating the importance of establishing a reference interval for the individual assay.
The main feature of the present EIA was the use of covalent coupling of a hemisuccinate derivative of 25(OH)D3 onto CovaLink microplates. This model of an assay could be adapted for measuring other steroid molecules. This new EIA appeared adequate to estimate 25(OH)D3, and it had several advantages compared with the RIA; the time-consuming liquid scintillation counting was omitted and the results were obtained within the same day of incubation. In conclusion, this EIA can be used as a rapid screening test for vitamin D status and for monitoring a patient's response to vitamin D3 therapy.
| Footnotes |
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| References |
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The following articles in journals at HighWire Press have cited this article:
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K. Eatwell Plasma concentrations of 25-hydroxycholecalciferol in 22 captive tortoises (Testudo species) Vet Rec., March 15, 2008; 162(11): 342 - 345. [Abstract] [Full Text] [PDF] |
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M. Vogeser, A. Kyriatsoulis, E. Huber, and U. Kobold Candidate Reference Method for the Quantification of Circulating 25-Hydroxyvitamin D3 by Liquid Chromatography-Tandem Mass Spectrometry Clin. Chem., August 1, 2004; 50(8): 1415 - 1417. [Full Text] [PDF] |
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